Eat Today, Starve Tomorrow

The newest craze to hit the world is the Alternate Day Diet, otherwise known as the Up Day Down Day diet, developed by New Orleans plastic surgeon, Dr James Johnson. Is this just another fad diet, soon to lose its popularity – or is it for real? We talk to the experts to shed some light on the subject. 

Eat what I like on one day, fast the next

After struggling to lose weight – and witnessing his patients’ constant battle with the bulge, Dr James Johnson dedicated his research to finding a way to help himself and others achieve weight loss and overall body health. On up-days you are allowed to eat whatever you like on the diet and the next, you have to limit your intake to 20 percent of what you normally eat, at about 500 calories. Sound easy? According to Dr Johnson it is. By restricting the caloric intake in this way, the body undergoes a mild form of stress and in turn activates a gene called SIRT1, also known as the ‘skinny gene’.  According to his research conducted on mice, this gene helps the body to lose fat by releasing it from around the organs. Dr Johnson explains that the diet plan also decreases the risk of disease, such as heart disease, stroke, Alzheimer’s, Parkinson’s, asthma, allergies, arthritis and diabetes. 

Red, red wine and resveratrol

In conjunction with the alternate day eating plan, Dr Johnson recommends taking his specially formulated supplement, containing Resveratrol, which is a molecule found in red wine, believed to turn on the SIRT1 gene. In 2003, research conducted on the substance showed that resveratrol could boost the lifespan of yeast by 70%, as well as round worms, fruit flies and fish. A later study in 2006 showed that resveratrol could increase the lifespan of mice, reduce their risk of heart disease and other age-related diseases. Presently, Dr Johnson and other scientists are conducting human trials to confirm that resveratrol has the same effects in humans as it does in the other organisms that have been tested. 

Professor Louise Warnich of the Department of Genetics, Stellenbosch University questions Dr Johnson’s rigorous promotion of resveratrol to trigger the SIRT1 gene. “The SIRT1 gene is one of the approximately 20 000 genes present in the nuclei of human cells. Gene activation or gene regulation is a complex process and not completely understood yet.  It has been shown that the SIRT1 gene can be activated by resveratrol, but also by other activators,” she says. “Resveratrol, on the other hand, also activates other targets. Until these complex interactions are elucidated, and the results of proper clinical trials in humans are available, it seems premature to promote the use of resveratrol for the activation of SIRT1, especially since human trials are only now underway to gauge its true effectiveness. It is thus strange that Dr Johnson is promoting his product long before answers to these questions are available.”

According to Professor Michele Ramsay, at the National Health Laboratory Service and University of the Witwatersrand, there is a lot more in red wine besides resveratrol – and some of these compounds may cause more harm than the proposed benefits as described by Dr Johnson. “There should be a guard against the notion that everyone will respond in the same way to resveratrol, especially since not enough research has been done to fully understand its effects.”

The good, the bad and the ugly

The alternate day diet would seem attractive since it does not have long-term restrictions on what people can eat, says Bronwen de Klerk, nutritional therapist, who runs a mindful eating programme called ‘The Middle Weigh’ at her Cape Town-based health studio, Chi-Netix. “People are able to restrict themselves for only one day, knowing that they can eat any of their favourite foods on the following day,” she says. “Eating very few calories on each alternate day would have similar benefits to fasting – giving the body a rest from its digestive processes, helping people to get more in touch with sensations of hunger and helping to break emotional attachments to food.” 

Registered dietician, Lila Bruk agrees that there may be some advantage to this diet, but suggests that those considering this diet exercise caution in that the disadvantages outweigh the advantages. “This diet gives one the opportunity to eat whatever one wants, while still losing weight.  Some research has also suggested that this pattern of eating has an anti-inflammatory effect and may slow down aging, but more research is needed to clarify this,” she says. “However, the disadvantages are that it may exacerbate a pre-existing eating disorder or predispose an eating disorder to manifest. In addition, it may not always fit into one’s lifestyle and it is likely to not be sustainable. Also, there are many other genes related to weight-loss that are yet to be discovered – and therefore it is important not to focus solely on the function of the SIRT1 gene for weight loss.”

Just another fad diet?

On down-days, apart from releasing the SIRT1 gene, the body could also release cortisol – a stress hormone – to cope with the very strict diet of just 500 calories on down-days, and in response, the body would then accumulate more fat, says registered homeopath, acupuncturist and Chinese medicine practitioner, Dr Debbie Smith. “Dysglycaemic patients could experience dizziness or fainting spells. Stable blood sugar and appropriate portion control are more likely to be healthy for the patient,” she says. “‘Serial’ dieters with eating disorders may binge eat on up-days and are possibly less likely to control their eating on down-days – and so, will not be able to stick to the plan. I feel that bingeing and fasting is not necessarily in line with the normal human dietary pattern.”

Sports and family physician at the Rosebank Centre for Sports medicine and Randburg Medicross, Dr Andrew Shaun Branfield agrees. “The alternate day diet is not based on good science, as to stimulate the metabolic rate, a person needs to eat regularly,” he says. “Conversely, to fast on alternate days, the dieter will find it increasingly difficult to maintain and even achieve a low body weight due to the reduction in metabolic rate.” 

Cause for some alarm bells?

Whilst the diet outlines the principles on which it is based, there is very little in terms of a structured day-to-day meal plan that reinforces these principles and the concern exists that people will continue to make poor choices, says nurse, midwife, massage therapist and nutritionist, Enid Hudson. “Any diet that is below 1000 calories a day is too low to get all the essential nutrients. This makes it all the more important to keep a food diary to make sure you top up with the right nutrients on the up-days – and choose nutrient-rich, healthy foods, without over-indulgence in unhealthy options,” she says. “I would also be concerned about people who have to operate heavy machinery or those who have to concentrate for long periods of time, especially on the down-days, as their blood sugar levels will dip considerably.”

Clinical director, Anstice Wright of the Oasis Counselling Centre in Plettenberg Bay is an accredited psychotherapist who specialises in addictions and eating disorders. Upon learning about the alternate day diet, she showed the plan to a few of her clients, living with eating disorders, for their thoughts on it. “They laughed at the plan, saying that they would either not be able to stop eating or would not be able to stop starving – and thought it was a joke,” she says. “For women who are desperate to lose weight, the mixture of a pill, the ‘out of control’ eating followed by not eating and the possibility of losing weight fast – is very attractive. I treat many people who have tried similar ways of losing weight and it has not worked.” The Oasis Counselling Centre aims at helping patients to live a normal, healthy life – and to fit into society seamlessly. “What if you are asked out for a meal on your down-day?  And, what if you have children – what are they going to learn from this constant binge and starve behaviour? I would not want to live with the emotional ups and downs that such a way of living would produce.”

Back to basics

Eating only when hungry and not eating until over-full is always the key to losing weight, says de Klerk. “Once you can master that - and you no longer need food as a crutch to deal with emotions – you can start to refine your food selections. You will then be selecting healthier foods from a position of strength and self-respect, not because you have to lose weight,” she says. “Combining balanced exercise is always beneficial to weight loss. Exercise also improves your state of mind, therefore making you less likely to need food to give you a lift.  There is no miracle diet out there that is going to solve our weight issues. We all just need to learn how to attain a balanced perspective on food and eating. The answers come from within - when we listen.”

Dr Branfield shares some guidelines to help distinguish a suitable weight-reduction programme, from a fad diet:

• A safe weight-loss programme should be based on the individual’s lifestyle and medical history. 

• A sensible programme should meet the dietary requirements from a wide variety of foods from all the food groups, rather than relying on mineral and vitamin supplementation. 

• It must meet adequate energy requirements on a daily-basis. The energy must be spread out over the whole day to avoid lethargy ‘spots’ and hunger. 

• A realistic goal for weight-loss should be aimed for, that is, approximately half a kilogram to one kilogram per week. Greater weight loss indicates a loss of fluid and lean-body tissue, in addition to body fat. 

• Information on scientific outcomes for the diet programme should be presented in a factual and specific manner, rather than via an anecdote (word-of-mouth) and testimonials.

• Permanent weight-loss is achieved through gradual but life-long changes. Avoid programmes that promise dramatic results or guarantee fast success. 

• Check that the programme has been developed or recommended by a person qualified in the field of nutrition, bearing in mind that very few doctors are nutritionists. 

“Weight loss is a combination of physical, mental and emotional factors – and each of these need to be considered in turn,” says Smith:

• Physical: You need to consider what you eat, how much you eat and the amount of exercise you do. Sensible food choices, portion control, food preparation choices and the variety of food also need reflection. 

• Mental: When we are stressed out, cortisol levels are elevated in the body. This would have a knock on effect on the blood sugar and insulin levels. Cortisol also contributes to inflammation and prevents weight loss in the body.

• Emotional: Our bodies might be holding on to weight that helps to make us feel safe. For example, you might be having a difficult time with your spouse, and subconsciously you become fatter to create a physical barrier between yourself and partner. Some people become fat subconsciously to create a power of authority. 

Author: Charlene Yared-West, Longevity Magazine, November 2010, p78.